NDR Pacific, Inc

Primary specialty

Substance Abuse Rehabilitation FacilityTaxonomy code 324500000X

License

300306AP Issued in CA

Legal business name

NDR PACIFIC, INC

Doing business as

California Coast Detox & Rehab

Practice address

24482 Caracas St
Dana Point, CA 92629-1320

Phone

(949) 218-8174

Fax

(866) 703-9903

NPI assigned

Mar 31, 2015

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Reiner Vincent Nusbaum

Title

Administrator

Phone

(949) 235-8258

Specialties & licenses 4

Addresses

Other names 1

• California Coast Detox & Rehab Doing business as

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1427760000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1427760000000",
    "number": "1023403714",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "806 AVENIDA PICO",
            "address_2": "SUITE I-284",
            "city": "SAN CLEMENTE",
            "state": "CA",
            "postal_code": "926735639",
            "telephone_number": "949-235-8258",
            "fax_number": "866-703-9903"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "24482 CARACAS ST",
            "city": "DANA POINT",
            "state": "CA",
            "postal_code": "926291320",
            "telephone_number": "949-218-8174",
            "fax_number": "866-703-9903"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NDR PACIFIC, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-03-31",
        "last_updated": "2015-03-31",
        "status": "A",
        "authorized_official_last_name": "NUSBAUM",
        "authorized_official_first_name": "REINER",
        "authorized_official_middle_name": "VINCENT",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "949-235-8258"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "CA",
            "license": "300306AP",
            "primary": false
        },
        {
            "code": "101YM0800X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor, Mental Health",
            "state": "CA",
            "license": "300306AP",
            "primary": false
        },
        {
            "code": "101YP2500X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor, Professional",
            "state": "CA",
            "license": "300306AP",
            "primary": false
        },
        {
            "code": "324500000X",
            "taxonomy_group": "",
            "desc": "Substance Abuse Rehabilitation Facility",
            "state": "CA",
            "license": "300306AP",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "California Coast Detox & Rehab",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Substance Abuse Rehabilitation Facility in Dana Point, CA
• Providers in Dana Point, CA by specialty
• Substance Abuse Rehabilitation Facility in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 31, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.